Zhang Yewu, Tao Fangbiao, Yin Huiping, Zhu Xiaoming, Ji Guoping, Kong Shenghua, Song Qinhua, Chen Jianhua, Chu Chengzhi, Li Zhu
Institute of Reproductive and Child Health, Health Science Center, Peking University, 38 Xueyuan Road, Haidan District, 100083 Beijing, PR China.
Public Health Nutr. 2007 Jul;10(7):733-8. doi: 10.1017/S1368980007246609. Epub 2007 Mar 5.
This study aimed to explore the associations between breast-feeding, dietary intakes and other related factors and subclinical vitamin A deficiency (SVAD) in children aged 0-5 years in an area in China where mild vitamin A deficiency (VAD) is found.
Data were from a population-based cross-sectional study with 1052 children aged 0-5 years. SVAD cases were identified by the indicator of serum retinol<or=20 microg dl(-1). Breast-feeding status, dietary intakes and other factors were collected through a pre-designed questionnaire.
The prevalence of SVAD in children aged 0-5 years was 6.9%. Logistic regression analysis showed that the odds ratio of SVAD for breastfeeding was 3.56 (95% confidence limits (95% CL) 2.17-5.82). After adjustment for sex, age in categories, residence, mother's education, mother's occupation, vitamin A preparation supplements, rank in siblings and diarrhoea, the odds ratio for breast-feeding fell to 2.38 (95% CL 1.13-4.95). The odds ratios for breast-feeding within children aged 1 year were 5.46 (95% CL 2.07-15.03) and 4.6 (95% CL 1.72-12.82) before and after adjustment of other confounders, respectively. The odds ratios for breast-feeding did not show statistical significance within children aged 0 or 2 years. The odds ratios decreased, but remained statically significant after further adjustments for individual dietary factor or all dietary factors.
Breast-feeding was a risk factor of SVAD for children, especially for those aged 1 year. The differences in dietary intakes and other established risk factors could not fully explain the increased risk. This finding implies that prolonged breast-feeding alone may not ensure protection of children from VAD in an area with mild SVAD.
本研究旨在探讨中国某存在轻度维生素A缺乏（VAD）地区0至5岁儿童的母乳喂养、膳食摄入及其他相关因素与亚临床维生素A缺乏（SVAD）之间的关联。
数据来自一项基于人群的横断面研究，共纳入1052名0至5岁儿童。通过血清视黄醇≤20μg/dl这一指标确定SVAD病例。母乳喂养状况、膳食摄入及其他因素通过预先设计的问卷收集。
0至5岁儿童中SVAD的患病率为6.9%。逻辑回归分析显示，母乳喂养儿童患SVAD的优势比为3.56（95%置信区间（95%CL）2.17 - 5.82）。在对性别、年龄分组、居住地、母亲教育程度、母亲职业、维生素A制剂补充、兄弟姐妹排行及腹泻情况进行调整后，母乳喂养的优势比降至2.38（95%CL 1.13 - 4.95）。在调整其他混杂因素之前和之后，1岁儿童母乳喂养的优势比分别为5.46（95%CL 2.07 - 15.03）和4.6（95%CL 1.72 - 12.82）。0岁或2岁儿童母乳喂养的优势比未显示出统计学意义。在进一步对个体膳食因素或所有膳食因素进行调整后，优势比虽有所下降，但仍具有统计学意义。
母乳喂养是儿童发生SVAD的危险因素，尤其是1岁儿童。膳食摄入及其他已确定的危险因素的差异不能完全解释这种增加的风险。这一发现表明，在存在轻度SVAD的地区，仅延长母乳喂养可能无法确保儿童免受VAD影响。
